Healthcare Provider Details

I. General information

NPI: 1831098508
Provider Name (Legal Business Name): CARE BEHAVIOR THERAPY SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 REGISTRY BLVD SUITE 105/OFFICE 107
ST. AUGUSTINE FL
32092-3831
US

IV. Provider business mailing address

190 REGISTRY BLVD SUITE 105/OFFICE 107
ST. AUGUSTINE FL
32092-3831
US

V. Phone/Fax

Practice location:
  • Phone: 305-986-5248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARIO JESUS COLLAZO
Title or Position: OWNER
Credential:
Phone: 305-986-5248